Understanding The Healthcare Reform Debate: The Uninsured

Over the last 2 weeks I wrote a series about retail clinics. While these clinics might represent a significant change in the way healthcare is being delivered in our country, the truth is most Americans are concerned about one and only one healthcare issue that is likely to substantially change their lives, namely healthcare reform.

With so much being written and said about the issue in newspapers, blogs, TV ads, town-hall meetings and cable news networks, I hesitated before I decided to write on the issue. However, through numerous conversations that I have had with friends, family members and even random people that I met at the airport or the coffee shop over the last month, I became more and more concerned by the extent of confusion and misinformation surrounding the healthcare debate.

While running the risk of adding more fuel to the confusion fire, my hope through this new series is to provide some useful, easy-to-understand and most importantly non-political information to help readers make better sense of the discussion. While the public is definitely very passionate about healthcare reform, recent polls show that 62% of those over 65 and 43% of those under 65 are confused about the various reform proposals.

But before I start talking about the HR 3200 Tri-Conference Bill or what a healthcare co-op is all about, it might be a good idea to go back to some healthcare 101 and clarify some basic stuff.

One term that keeps coming up in every conversation is the uninsured. Unless you have been hiding under a rock, you should know by now that there are 46 million people that are uninsured in our country. But few people have bothered to stop and ask: who are the uninsured?

What most people don’t realize is not that all uninsured are poor people who can’t afford to buy coverage. Actually, 40% of the uninsured (roughly 18 million people) are uninsured by choice, meaning that they earn enough money to buy coverage (their income is more than 2.5 times the poverty level), but they have decided not to buy coverage because they consider themselves healthy (the so-called "young invincibles").

The other 60%, roughly 22 million people, are uninsured because they cannot afford to buy coverage (their income is less than 200% of the poverty level). But don’t we have a program that is specifically designed to cover poor people? Why aren’t these people covered by Medicaid? Actually, you have point. Data shows that around 12 million uninsured are not enrolled in public programs that they would qualify for because they are unaware of the programs, don’t know how to enroll, or because they fear the negative stigma associated with it.

So if you believe the math so far, that leaves us with 16 million people. Why aren’t they covered by Medicaid? Two reasons: these are people that don’t earn enough money to afford health care coverage (or are self-employed or work for small companies), but are not so poor that they can qualify for Medicaid. Or they are undocumented (illegal) immigrants and thus can’t qualify for any program.

So now that we have explained who the uninsured are, the next logical question is why should the majority of us -- the 169 million employer-based insured and 17 million self-insured -- care about this? And why is this uninsured issue so central to the healthcare reform debate?

The truth is most middle-class and upper-class Americans don’t even get in contact with uninsured people. But do you really want to see uninsured people face-to-face? All you need to do is to drive to your county hospital’s ER on any night of the week or weekend and you will see tens and hundreds of people helplessly waiting for 6, 8 or even 12 hours so they can be seen by a doctor.

Still some people might be asking, what’s the big deal? And why should I care? Well, to start with, care delivered at the ER is three to four times more expensive a visit to the primary care doctor. So who absorbs this cost when people can’t pay? Hospitals and doctors get some funds from the government, but they also end up charging health insurance plans more to recover their losses. Insurance plans, then pass that cost to us, the employer-based insured or self-insured, through higher premiums.

So if the moral and ethical argument don’t work for us, maybe the financial argument will: our insurance premiums keep escalating every year partly because we are subsidizing for very expensive care provided to the uninsured.

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